Published on Investing in Health

Reducing the health burden due to pollution

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Photo: © Simone D. McCourtie / World Bank

Heavy smog compelled New Delhi to declare a pollution emergency last week. As air pollution soared to hazardous levels and residents donned masks, India’s capital took a series of measures, such as banning most commercial trucks from entering the city and closing all schools, in response to the air quality crisis. Many residents complained of headaches, coughs and other health concerns, and poor visibility caused major traffic accidents.

However, those in New Delhi aren’t the only ones suffering the consequences of pollution. Globally, pollution accounted for an estimated 9 million, or 16 percent, of all premature deaths worldwide in 2015, according to a report released last month by The Lancet Commission on Pollution and Health. This is three times more deaths than AIDS, malaria and tuberculosis combined; 15 times as many deaths as war and all forms of violence; and more deaths than alcohol (2.3 million deaths), road accidents (1.4 million) or child and maternal malnutrition (1.4 million).
The Commission also reports that pollution-related diseases cause productivity losses equivalent to about 2 percent of gross domestic product per year. They also result in healthcare costs that are responsible for 1.7 percent of annual health spending in high-income countries and for up to 7 percent of health spending in middle-income countries that are heavily polluted and rapidly developing.  Welfare losses due to pollution are estimated at US$ 4.6 trillion per year – equivalent to 6.2 percent of global economic output.
Far from being a rich person’s problem, pollution disproportionately kills the poor and vulnerable. Nearly 92 percent of all pollution-related deaths occur in low-income and middle-income countries.  Children are especially at high risk of pollution-related disease, with exposure to pollutants during times of vulnerability in utero and early infancy leading to higher risk of disease, disability and death in childhood and across their lifespan.
Pollution of the air outside and inside our homes, of waterways and coastal zones and of land all contribute to the health burden reported by the Lancet. Ambient air pollution, chemical pollution and soil pollution are all increasing, with the biggest rise found in rapidly developing and industrializing low-income and middle-income countries. Household air and water pollution were, the Lancet added, slowly declining, which is some good news.
To help curb this massive health and environmental burden, the World Bank Group works with developing countries and our partners to reduce pollution, implement proper waste management, improve water and air quality and promote clean development for healthier lives and improved economic opportunity. World Bank commitments (IBRD/IDA) to pollution management and environmental health totaled more than US$ 7 billion between fiscal year 2009 and 2016. These commitments are well aligned with the World Bank Group’s twin goals of eradicating extreme poverty and boosting shared prosperity.

Tackling this pollution problem takes actions on many fronts and requires sustained effort.  We need better monitoring of the problem and improved public awareness. We need regulation and enforcement of those regulations. We need good contract management for polluting industries. We need traffic management and vehicle maintenance. We need behavior change. And sometimes we have to clean up polluted sites. The diversity of constituencies also points to a need for customized messaging that will resonate with each audience. In addition, leadership – at the local, country and global levels – is needed to initiate and sustain coalitions for change, identify large-scale solutions, formulate and enforce regulations and secure financing for pollution prevention and reduction programs. 
Much of the work ahead requires partnerships across sectors and institutions. These institutions include the World Health Organization as the global leader in health, think tanks, civil society organizations, multilateral and financiers, bilateral financiers, foundations and the private sector. Building on our track record and working across multiple sectors – environment, health, governance, energy, water, macroeconomics and fiscal management -- the World Bank can further support countries to inform policy change and to improve governance, institutional capacity, communications and behaviors to reduce pollution. These, combined with investments in prevention and cleaning up, will help to curtail pollution as a major drag on public health and economic growth.


Olusoji O. Adeyi

Director, Global Practice, Health, Nutrition & Population

Julia Bucknall

Director for Environment and Natural Resources

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